HomeMy Public PortalAbout9920 OLIVE ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER y BUILDING
ADDRESS
FOR APPLICANT p FI�L IN ,, LOCALITY
BUILDING L' NEAREST h k
ADDRESS �'/'I,�"`- [' Lam, Gr' �-
� Y' CROSS ST.
LOCALITY /�74/t (�, Of NO. SERIAL NO. PERMIT NO.
NEAREST r e '', A /�� ( J s
CROSS ST. e� !,10111 ^-^- % / 3 � /
/ RECEIVED BY Ready for Innpeetlon DATE ISSUED
OWNERMAI L /�
ADDRESS ` ' t �` 4�' /(� USE LONE OCCUP�NCY BK MAP PG
CITY �_ TELAO. I �Ji`
CONTRACTOR X'c > J}/Gk
CO.IMP.N0.
ADDRESS kit. f 11i L 4 / 10B NO.
CITY , #/ , ,,, TE{L.NOZ),: -/7J I,7 � TRUNK PERMIT NO.
REGISTRATION N0. CTTATE �- "
ROAD PERMIT NO. A 1
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT`�' NO.OF BLDGS. 2�
J ll x f YL' NOW ON LOT CHARGES
USE OF /
BUILDINGS (_�bL-t-�-C CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE ,--
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 l RECEIPT NO. DATE (BY
HOUSE SEWER CONNECTING 70
PR;VATE DISPOSAL SYSTEM 1.00
WORK TO HOUSEISEWER BLDG.ONAL OR 1 00
S (�"L EXCEPTION RECORDED
ALTER OR REPAIR EXISTING NO. DATE I BY
EWER OR DISPOSAL SYSTEM 1.00
DlSCUNNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION S DEPTH y
CESSPOOL—DRYWELL —
SPECIAL CONDITIONS ONLY 2.00 ANHOLE REFEREN E-- '
,6 UPPER C^ LBWER
TYPE OF CONNECTION LENGTH F OM
OWNERS PERMIT s 00 Y._ e CURB az i.. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE :S—t —
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNEC.T"fHE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS fNSPECTOR'SSIGNATURE GATE
jjL
SIGNED THIS..--.�_,t...-DAY OF-__... ..--.19-0NEW HOUSE SEWER '
OWNER OR (�{ /� /Y Y' CONNECT ADDITIONAL
OWNERS AGENT....--._`--:.zLkS. -.- .Y_- -:--_- BUILDING CR WORK
-------------
ADDRESS__-------------------_-.._ SEPTIC TANK.SEEP.PIT(S)
........ --------------------------..............-- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] ORYWELL C]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSECIq AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CA4.IFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVA DESCRIBED RESIO NTIAL PROPER Y. BACKFILL SEPTIC TANKS
SIGNATURE / I ��, SEEP.PIT(S)� CESSPOOLS
OF PERMITTEDZ�..... ---4'.� r�
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